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      Sarcopenia and physical independence in older adults: the independent and synergic role of muscle mass and muscle function

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          Abstract

          Background

          The loss of skeletal muscle mass (MM) or muscle function (MF) alone increases the risk for losing physical independence in older adults. We aimed to examine the independent and synergic associations of low MM and low MF, both criteria of sarcopenia, with the risk for losing projected physical independence in later life (+90 years old).

          Methods

          Cross‐sectional analyses were conducted in 3493 non‐institutionalized older adults (1166 males). Physical independence was assessed with a 12‐item composite physical function scale. Logistic regression was used to estimate the odds‐ratio (OR) for being at risk for losing physical independence.

          Results

          Approximately 30% of the participants were at risk for losing physical independence at 90 years of age. Independent analysis demonstrated that participants with low MM had 1.65 (95%CI: 1.27–2.31) increased odds for being at risk for losing physical independence and participants with low MF had 6.19 (95%CI 5.08–7.53) increased odds for being at risk. Jointly, having a low MM and a low MF increased the risk for losing physical independence to 12.28 (95%CI 7.95 to 18.96).

          Conclusions

          Although low MM represents a risk factor for losing physical independence, low MF seems to play a more dominant role in this relationship, with the presence of both sarcopenia criteria representing a substantial risk for losing physical independence in later life.

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          Most cited references30

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          Epidemiology of sarcopenia among the elderly in New Mexico.

          Muscle mass decreases with age, leading to "sarcopenia," or low relative muscle mass, in elderly people. Sarcopenia is believed to be associated with metabolic, physiologic, and functional impairments and disability. Methods of estimating the prevalence of sarcopenia and its associated risks in elderly populations are lacking. Data from a population-based survey of 883 elderly Hispanic and non-Hispanic white men and women living in New Mexico (the New Mexico Elder Health Survey, 1993-1995) were analyzed to develop a method for estimating the prevalence of sarcopenia. An anthropometric equation for predicting appendicular skeletal muscle mass was developed from a random subsample (n = 199) of participants and was extended to the total sample. Sarcopenia was defined as appendicular skeletal muscle mass (kg)/height2 (m2) being less than two standard deviations below the mean of a young reference group. Prevalences increased from 13-24% in persons under 70 years of age to >50% in persons over 80 years of age, and were slightly greater in Hispanics than in non-Hispanic whites. Sarcopenia was significantly associated with self-reported physical disability in both men and women, independent of ethnicity, age, morbidity, obesity, income, and health behaviors. This study provides some of the first estimates of the extent of the public health problem posed by sarcopenia.
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            Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care.

            Three terms are commonly used interchangeably to identify vulnerable older adults: comorbidity, or multiple chronic conditions, frailty, and disability. However, in geriatric medicine, there is a growing consensus that these are distinct clinical entities that are causally related. Each, individually, occurs frequently and has high import clinically. This article provides a narrative review of current understanding of the definitions and distinguishing characteristics of each of these conditions, including their clinical relevance and distinct prevention and therapeutic issues, and how they are related. Review of the current state of published knowledge is supplemented by targeted analyses in selected areas where no current published data exists. Overall, the goal of this article is to provide a basis for distinguishing between these three important clinical conditions in older adults and showing how use of separate, distinct definitions of each can improve our understanding of the problems affecting older patients and lead to development of improved strategies for diagnosis, care, research, and medical education in this area.
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              Development and validation of criterion-referenced clinically relevant fitness standards for maintaining physical independence in later years.

              To develop and validate criterion-referenced fitness standards for older adults that predict the level of capacity needed for maintaining physical independence into later life. The proposed standards were developed for use with a previously validated test battery for older adults-the Senior Fitness Test (Rikli, R. E., & Jones, C. J. (2001). Development and validation of a functional fitness test for community--residing older adults. Journal of Aging and Physical Activity, 6, 127-159; Rikli, R. E., & Jones, C. J. (1999a). Senior fitness test manual. Champaign, IL: Human Kinetics.). A criterion measure to assess physical independence was identified. Next, scores from a subset of 2,140 "moderate-functioning" older adults from a larger cross-sectional database, together with findings from longitudinal research on physical capacity and aging, were used as the basis for proposing fitness standards (performance cut points) associated with having the ability to function independently. Validity and reliability analyses were conducted to test the standards for their accuracy and consistency as predictors of physical independence. Performance standards are presented for men and women ages 60-94 indicating the level of fitness associated with remaining physically independent until late in life. Reliability and validity indicators for the standards ranged between .79 and .97. The proposed standards provide easy-to-use, previously unavailable methods for evaluating physical capacity in older adults relative to that associated with physical independence. Most importantly, the standards can be used in planning interventions that target specific areas of weakness, thus reducing risk for premature loss of mobility and independence.
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                Author and article information

                Contributors
                lsardinha@fmh.ulisboa.pt
                Journal
                J Cachexia Sarcopenia Muscle
                J Cachexia Sarcopenia Muscle
                10.1007/13539.2190-6009
                JCSM
                Journal of Cachexia, Sarcopenia and Muscle
                John Wiley and Sons Inc. (Hoboken )
                2190-5991
                2190-6009
                08 November 2016
                April 2017
                : 8
                : 2 ( doiID: 10.1002/jcsm.v8.2 )
                : 245-250
                Affiliations
                [ 1 ] Study and Research Group in Metabolism, Nutrition, and Exercise GEPEMENEState University of Londrina ‐ UEL LondrinaBrazil
                [ 2 ] Exercise and Health Laboratory, CIPER, Faculdade de Motricidade HumanaUniversidade de Lisboa LisboaPortugal
                Author notes
                [*] [* ] Correspondence to: L. B. Sardinha, Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, 1499‐002 Cruz Quebrada – Dafundo, Portugal. Email: lsardinha@ 123456fmh.ulisboa.pt
                Article
                JCSM12160 JCSM-D-15-00215
                10.1002/jcsm.12160
                5377449
                27897417
                edac5d08-e338-4db8-9f43-aba9229540b9
                © 2016 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf on the Society on Sarcopenia, Cachexia and Wasting Disorders

                This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 26 November 2015
                : 07 July 2016
                : 27 September 2016
                Page count
                Figures: 1, Tables: 3, Pages: 6, Words: 2816
                Funding
                Funded by: Capes Foundation within the Ministry of Education, Brazil
                Award ID: 88887.065407/2014‐00
                Award ID: 88887.090477/2014‐00
                Funded by: Portuguese Foundation for Science and Technology
                Award ID: SFRH/BPD/92462/2013
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                jcsm12160
                April 2017
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.0.9 mode:remove_FC converted:03.04.2017

                Orthopedics
                sarcopenia,dynapenia,elderly,physical independence
                Orthopedics
                sarcopenia, dynapenia, elderly, physical independence

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